Fortunately the Guerra family has realized several milestones in the last six months. My eldest child graduated from college, my youngest graduated from high school, and both my middle and youngest are attending college this fall. In addition, my daughter has the great privilege of playing a sport for her school in Boston and, therefore, I have the dubious honor of traveling over four hours north two times a week to cheer on my favorite athlete. Now these travels are same day round trip, mind you, which allows me to log over nine hours on the road in one afternoon! Three and a half hours into the drive home, about the time I see the signs for Suffern, NY, my facial muscles, jaw, molars and neck are as tight as a drum. As I maneuver from one lane to the next, in an effort to expedite my arrival home, I begin steering with one hand while attempting to massage my cheeks and neck to relieve the tightness that has developed during these last hours on the road.
Am I Clenching?!! Sufferin-succotash!!!
I have now joined the millions of Americans that clench their teeth, often unconsciously, and in my case, in response to tension and stress.
Studies have shown 50-95% of men, women, and children clench their teeth at some point in their lifetime, with up to 8% of the population grinding regularly, leading to chronic discomfort including pain and tightness in the jaw, facial muscles, TMJ, tooth tenderness and looseness and ear and neck discomfort.
Bruxism, or clenching, is often an unconscious act of grinding, gnashing or clenching of teeth. A primary cause of clenching is stress and anxiety and it is estimated that 70% of grinders have some form of stress in their lives. It is most commonly done while we sleep, and therefore incredibly difficult to stop or manage. Malpositioned or crooked teeth can add isolated force to specific teeth and equally impact our desire to clench and accelerate bone loss and tooth mobility.
In addition, studies prove that those suffering from sleep apnea, now estimated to be 1 in 15 Americans, will clench or grind their teeth in an effort to open the airway and clear the obstruction to allow breathing to begin again.
SYMPTOMS AND DIAGNOSIS
Symptoms of clenching and grinding (Bruxism) may include soreness or tightness in the facial muscles and jaw, sore teeth, chronic dull headache, ear pain, neck tightness, looseness or a feeling of loose teeth. Symptoms can develop quickly with an acute or short term episode of grinding when there is a rise in stress and anxiety. More chronic (long term) bruxing can lead to prolonged discomfort and irreversible damage like bone loss around the teeth. The constant pressure and bumping of teeth that accompanies grinding can be likened to my mailbox after a long winter. Inevitably I have to re-secure the post after each season of heavy snow and having snow plows bumping and exerting force into the post. With each pass and knock, the post becomes loose over time and the dirt erodes around it. Similar ideas can be imagined for a tooth that is heavily pressured by clenching and grinding, subsequently causing bone loss and a permanent loss of support.
The dentist and hygienist can also observe evidence of grinding on teeth. Much like an archeological dig, there are always footprints left behind that help us to determine the likelihood of activity, even if the patient is completely unaware.
Abfraction is a notching in the enamel at the gum line. Evidence shows that repeated pressure, like that with clenching and grinding, creates flexing of the tooth and, over time, causes a loss of thinner enamel. This weakened area can be detected by placing a fingernail at the gum line and feeling for a notch or divot. This loss of tooth structure can render the tooth severely compromised, requiring a filling or crown to provide the missing support.
Flattening of the biting surfaces and edges of teeth can also be observed, sometimes resulting in concavities or pitting in the enamel. Wear spots also expose the layer under the enamel, called dentin, and can become a sensitive unprotected area on the tooth. Bone loss can be determined and evaluated with the use of x-rays. Tooth loss has occurred as a result of extensive grinding and absence of support. In addition to the physiological trauma, clenching can damage restorations like fillings and crowns, resulting in cracks and breaks. The fracturing of tooth structure and loss in height of the tooth leads to restorative treatment necessary for proper occlusion.
The TMJ (temporomandibular joint) is actively involved with clenching and grinding and becomes inflamed from extensive use. Soreness upon opening and closing is often present, as well as popping, clicking and in extreme cases, locking of the jaw. (How are you going to eat that huge sub sandwich or chew that fabulous rib eye?)
HELP IS ON THE WAY! (and it’s not from the ACME Dental Company!)
Halting the habit of bruxism may not be possible in a day but controlling the clenching and the damage it causes is possible!
One of the most important steps in achieving success to stopping clenching is AWARENESS!
Many patients are not aware of their clenching often because it occurs while they sleep. Being cognizant of the position of your jaw and whether your teeth are touching or apart in a “relaxed” state helps to identify when and what triggers may be associated with the habit. Being alert to any soreness of teeth upon waking or fatigued facial muscles will help the dental professionals isolate the times of clenching. I have had patients admit to clenching while driving in traffic, typing on the computer and even while texting on their phone, completely unaware until they developed a heightened realization to the possibility. My own daughter, suffering from headaches on a daily basis, was amazed when she realized that she too would find her teeth firmly closed at times throughout the day. Holistic approaches to help decrease the likelihood of clenching and grinding are aimed at reducing stress and anxiety. Lowering stress, increasing rest and sleep and conscious relaxation and meditation throughout the day can help minimize clenching. It has been noted that caffeine can raise anxieties and jumpiness and alcohol has been shown to intensify the urge to clench during sleep. Avoiding these may help to reduce occurrence.
Muscle relaxants are used to reduce pain and give relief to more acute discomforts by giving the muscles time to settle down. Warm moist compresses can also be used to relieve tightness. A damp towel rinsed with warm or hot water and placed at the joint and cheek area may loosen the tension but it effects may be minimal.
Because many “clenchers” have the habit for years or a lifetime, the use of a custom occlusal guard, worn at night, helps to protect the teeth from harm and allows the jaw joint to glide freely over a smooth surface. Night guards have proven to be the most popular choice of treatment, providing protection while keeping the teeth separated and preventing them from locking together.
Orthodontics (Braces/Invisalign) provides proper occlusion, distributing bite force evenly to all teeth. After years of wishing and wanting, many adults are choosing the option of Invisalign and other orthodontic options to not only correct their bite and prevent bone loss and tooth loss, but to obtain straight teeth and the radiant smile they’ve always dreamed of.
Botox ( Botulinum toxin), is given as an injection into the muscles associated with clenching causing a temporary paralysis lasting approximately 3 to 6 months. The benefit of Botox is that it treats the cause or the source of the problem. Though other treatments are effective in providing relief, they only help to reduce trauma by protecting the teeth from further damage. Injecting Botox renders the facial muscles “weakened enough to stop involuntary clenching and grinding.”
“Th-th-th-That’s All Folks!”
Treatments are available and relief is in sight but, for the sufferers of clenching and grinding, sometimes assistance and a pain free lifestyle can’t come quick enough. Battling bruxism is an ongoing activity that requires patience, diligence and compliance. Many of the causes of clenching cannot be suppressed overnight. With the most common source thought to be stress, this time of the year brings a host of new reasons to start! In the last month patients have realized longer commutes and an increase in traffic, homework, sports schedules, eating dinner on the fly and all the other changes that occur with back to school responsibilities. In addition, with the holidays encroaching upon us, these next few months often aid to launch a grinding frenzy for even the calmest personalities. As you can ascertain from my own experiences, it doesn’t get easier! If life is driving you “Looney” we can help make it as comfortable as possible. Like my friend Pam always says….”We’re living the dream” and I’ll just do it with my night guard in place!
-by Julia Guerra, RDH, BA